Please complete and submit this form to request a new WIC card by mail. Your replacement WIC card will be mailed within 5 business days.

IMPORTANT: Requesting a new card with this form will automatically deactivate your current card. Keep this in mind if you plan to shop soon.

Use the date of birth for anyone in your family that is currently enrolled in WIC.

This form is for families enrolled in the PHFE WIC program.